DOI:http://dx.doi.org/10.7314/APJCP.2016.17.3.

1209
Age of Initiation, Determinants and Prevalence of Cigarette Smoking among Teenagers in Lagos State, Nigeria

RESEARCH ARTICLE

Age of initiation, Determinants and Prevalence of Cigarette

Smoking among Teenagers in Mushin Local Government Area
of Lagos State, Nigeria
AO Abiola1, OS Balogun2*, OO Odukoya1, FA Olatona1, TO Odugbemi1, RK
Moronkola3, AA Solanke4, OJ Akintunde5, OO Fatoba1

Abstract
Background: Cigarette smoking constitutes a major threat to the health and wellbeing of teenagers. While
smoking has been on decline in the developed countries, the reverse is the case in developing countries. The aim
of this study was to determine the age of initiation, determinants and prevalence of cigarette smoking among
teenagers in Mushin Local Government Area of Lagos state, Nigeria. Materials and Methods: This was a
descriptive cross-sectional study among 475 teenagers selected by multistage sampling. A pre-tested, structured,
interviewer-administered questionnaire was used for data collection. The study was carried out in November,
2014. Results: Response rate was 84.6%. Mean age of the respondents was 16.4±1.65years. Range and mean age
of initiation of cigarette smoking were 7 to 17 years and 12.0±3.32 years respectively. Teenagers who were above
15 years (OR:5.13, 95%CI: 0.87-30.26), males (OR:5.19, 95%CI: 1.57-17.18), married (OR:8.41, 95%CI: 1.04-
63.35), had ≤primary school education(OR:4.31, 95%CI: 1.07-17.33), influenced by friends(OR:308.84, 95%CI:
84.87-1123.81), and influenced by advertisements (OR:27.83, 95%CI: 3.92-197.64) were more likely to have
initiated cigarette smoking. Furthermore, teenagers who were males (OR:12.77, 95%CI: 2.90-56.28), married
(OR:19.24, 95%CI: 2.05-180.45), had ≤primary school education(OR:7.85, 95%CI: 2.37-26.01), influenced by
friends(OR:28.56, 95%CI: 10.86-75.07), and influenced by advertisements (OR:5.95, 95%CI: 1.72-20.61) were
more likely to be current cigarette smokers. In addition, 24.9% had initiated cigarette smoking while 14.7%
were current smokers of cigarette. Conclusions: Mean age of initiation of cigarette smoking was 12.0±3.32
years. Determinants of cigarette smoking were age, gender, marital status, educational background, friends
and advertisements. Life time prevalence of cigarette smoking was higher than prevalence of current cigarette
smokers. Cigarette smoking reduction programs should take these factors into consideration.
Keywords: Age of initiation - determinants of cigarette smoking - teenagers - prevalence - Nigeria

Asian Pac J Cancer Prev, 17 (3), 1209-1214

Introduction these, 700 million of them being males live in developing

countries. While smoking rates have been on the decline
Tobacco smoking remains a major public health in the developed countries, they have however been on the
concern particularly among young people (Odukoya et high side in the developing countries and it has increased
al., 2013). It is the leading preventable cause of mortality by as much as 50 %, especially in Asia and in the Pacific
and over five million people die globally from the effects region. Over the last decade about four million deaths
of tobacco every year. Every eight seconds someone, occurred annually as a result of about 50% increase in rate
somewhere in the world, dies as a result of using tobacco of smoking cigarette in developing countries.
(Leung et al., 2009). It is reported that by the year 2030, In Europe, an estimate of 26% of people aged 15 years
the death rate is estimated to exceed eight million people and above approximately 100 million people smoke on
a year Global Youth Tobacco Survey Collaborative Group a daily basis (AIHW, 2008). China and Indian, the two
(GYTS, 2002). world’s most populous nations are home to more smokers
According to the World Health Organization (WHO) than the entire European Union. In China alone, more
it is estimated that 1.1 billion people, representing a third than 300 million people are tobacco users while in India
of the world population above the age of 15 years, use about 275 million people use tobacco and about 57 million
tobacco, principally in the form of the cigarettes and of Indonesians are tobacco smokers (David, 2012). However
1
Department of Community Health and Primary Care, College of Medicine, University of Lagos, 2Lagos State Ministry of Education,
3
Department of Internal Medicine, Lagos University Teaching Hospital, 4Multichoice Nigeria Limited, 5Phamatex Industries Limited,
Lagos State, Nigeria *For correspondence: seunballo2004@yahoo.co.uk

Asian Pacific Journal of Cancer Prevention, Vol 17, 2016 1209

AO Abiola et al
in Africa, the prevalence of smoking varies from country
to country. In South Africa, 33.3% of males and 8.2% of
females smoke. In Kenya, 22.9% of males smoke and
0.7% of females smoke. In Ghana, 8.8% of males and
0.1% of females smoke. Comparatively, in Nigeria, 8.0%
of males and 0.5% of females smoke (Pampel, 2008).
Smoking of tobacco appears to be a well-entrenched
behaviour among teenagers. Adolescence period is seen
as a forming stage, a resistant period where young people
tries to form their own identity and also try to belong to a
particular stratified social group. Initiation of smoking at
a tender age is a behaviour that occurs at a time when the
persons involved are not fully equipped to make certain
decisions and these decisions may affect their inclination
to addiction and also influences adult smoking behavior.
Epidemiological study suggest that most tobacco users
begin as adolescents and individuals who reach their
mid-20s as nonsmokers are unlikely to ever become
tobacco users (Aldrich et al., 2015). It is estimated that
80% of adult regular smokers initiate tobacco use before
the age of 18 (Poynter, 2008). However, initiation of
tobacco in teenagers is usually due to interaction of
different factors which include intrapersonal, interpersonal
and environmental factors. Some intrapersonal factors
associated with adolescent smoking include lower levels
of knowledge on hazards of smoking (Yan et al., 2014),
low self-esteem (Karimy et al 2013; Nazarzdeh et al.,
2013). Peer pressure and having friends who smoke has
been considered as the most important factor influencing
the habit of smoking in adolescents in the western world;
(Schaefer et al., 2012), also motivation by smoking
behavior of parents and siblings, the media, secondhand
smoke exposure, curiosity, and a drive for experimentation
(Voorhes et al., 2011).
The earlier a smoker quits smoking the less the hazard,
as evidence suggests that much of the projected mortality
from smoking can be prevented by stopping. This study
seeks to determine the age of initiation, determinants

Table 1. Factors Associated with Initiation of Cigarette Smoking among Teenagers, Mushin LGA,
Initiation of cigarette smoking
Variables Frequency (%) Statistics & Pvalue
Initiated Never initiated
Age (Years)
≤15 84 (31.1) 186 (68.9)
>15 16 (12.1) 116 (87.9)
t=5.0315; df=400; p=0.0001
Total 100 (24.9) 302 (75.1)
Mean ± SD 17.07 ± 1.53 16.14 ±1.63 100.0
Gender
6.3
Male 87 (34.1) 168 (65.9)
X =31.8734; df=1; p=0.0001
2
Female 13 (8.8) 134 (91.2)
75.0
Marital Status
Unmarried 95 (24.1) 299 (75.9)
*p=0.0255 56.3
Married 5 (62.5) 3 (37.5)
Religion 50.0
Christian 45 (21.1) 168 (78.9)
*p=0.0418
Islam 55 (29.1) 132 (70.9)
Ethnic group 25.0
Yoruba 81 (26.7) 222 (73.3) 31.3
*p=0.0831
Others (Hausa/Fulani/ Igbo) 19 (19.2) 80 (80.8)
Educational Background 0
≤ Primary School 21 (48.8) 22 (51.2)
*p=0.0003
Newly diagnosed without treatment

≥ Secondary School 79 (22.0) 280 (78.0)

Friends influence
Yes 83 (94.3) 5 (5.7)
*p=0.0001
No 17 (5.4) 297 (94.6)
Advert influence
Yes 29 (90.6) 3 (9.4)
*p=0.0001
No 71 (19.2) 299 (80.8)
Parents influence
Yes 12(85.7) 2 (14.3)
*p=0.0001
No 88 (22.7) 200 (77.3)
Relatives influence
Yes 26 (87.7) 3 (10.3)
*p=0.0001
No 74 (19.8) 299 (80.2)
*Fisher’s Exact tests

1210 Asian Pacific Journal of Cancer Prevention, Vol 17, 2016


Age of Initiation, Determinants and Prevalence of Cigarette Smoking among Teenagers in Lagos State, Nigeria
and prevalence of cigarette smoking among teenagers in
Mushin Local Government Area of Lagos state, Nigeria.
Materials and Methods
Study location
Mushin local government area (LGA) in the Lagos
metropolis is one of the 20 LGAs in Lagos state, Nigeria.
It is one of the major commercial centres in Lagos state.
The 2006 census put the population of the LGA at 631,857,
with 326,873 males and 304,984 females. Mushin LGA
has 19 political wards. Each ward in Mushin LGA had
an average of 40 streets and each street had about 36
houses, each house had an average of ten households,
and each household consist of an average of five persons.
The Local Government is a socio-cultural diversity of the
typical Nigerian society because it is well represented by
various ethnic groups.
Study design
The study design was a descriptive cross-sectional
study among teenagers that were permanent residents
in Mushin LGA. The confidence interval and degree of
accuracy desired were set at 95% and 5% respectively. The
minimum sample size of 250 was determined using the
formula n = Z2pq/ d2for descriptive cross-sectional study
with the prevalence of tobacco use amongst adolescents
in a previous study carried out in Kajola LGA, Oyo state,
Nigeria of 0.205.13However, 475 respondents were
selected for the study. Respondents were selected by
multi-stage sampling method. In the first stage, one street
was selected from each ward by simple random sampling
method using balloting procedure. In the second stage, five
houses were selected from each selected street by simple
random sampling method using balloting procedure. In
the third stage, five households were selected from each
selected house by simple random sampling method using
balloting procedure. In the fourth stage, one teenager was
selected from each selected household by simple random
sampling method using balloting procedure. Where a
household has no teenager, another household is selected
to replace it. This study was carried out in November,
2014.
Data collection
A pre-tested structured interviewer-administered
questionnaire was used to collect information on socio-
demographic characteristics and tobacco cigarette smoking
among teenagers. The questionnaire was adapted from
previous studies and from the World Health Organization
Global Youth Tobacco Survey tool (CDC, 2008). The
questionnaire comprises of two sections: Section A had 6
questions on socio-demographic characteristics, section B
had 14 questions on tobacco cigarette smoking.
Data analysis
Data analysis was done using the Epi Info version
3.5.1, GraphPad Instat and WinPepi statistical software
packages. Chi-square and Fisher exact tests were used
to compare differences between proportions while t-test
was used for comparison of differences between means. P
Asian Pacific Journal of Cancer Prevention, Vol 17, 2016
DOI:http://dx.doi.org/10.7314/APJCP.2016.17.3.1209
values of ≤ 0.05 were considered statistically significant.
Logistic regression analyses were carried out to determine
factors associated with tobacco cigarette smoking. For
the multivariate analyses, all the variables that were
statistically significant on the bivariate were entered into
the multivariate analyses.
Ethical consideration: Approval for this study was
obtained from the ethics and research committee of the
Lagos University Teaching Hospital. Verbal informed
consent was obtained from each respondent.
Results
A total of 402 out of the 475 selected respondents
participated in the study; giving a response rate of 84.6%.
Mean age of the respondents was 16.37± 1.65years.
Majority of the respondents were males (63.4%),
unmarried (95%), Christians (53%), Yoruba by tribe
(75.4%) and had minimum of secondary school education
(89.3%) (Table1).
Less than one-third (24.9%) of the respondents had
ever smoked tobacco cigarette while 14.7% were current
cigarette smokers. The modal and mean age of initiation
of cigarette smoking was 15years and 12.00±3.32 years
respectively (Table2). Reasons for smoking initiation
were primarily friends (21.9%), advertisements (8.0%),
relatives (7.2%) and parents (3.5%). Sixty six (16.4%) of
the respondents like to smoke with friends, 10% like to
smoke always, 9.0% like to smoke when nervous, 6.7%
like to smoke when idle while 5.0% like to smoke when
over-worked.
A bivariate analysis showed that there were statistically
significant associations between the respondents’
age (p=0.0001), gender (p=0.0001), marital status
(p=0.0255), religion (p=0.0418), educational background
(p=0.0001), friends (p=0.0001), advert (p=0.0001), parent
(p=0.0001), relatives (p=0.0001) and initiation cigarette
smoking (Table 1). There were statistically significant
Table 2. Age of Initiation of Cigarette Smoking among
Teenagers, Mushin LGA, Lagos state, Nigeria, 2014
Age of initiation of cigarette Frequency (%)
smoking (Years) (n=100)
7 1(1.0)
8 2 (2.0)
9 4 (4.0)
10 7 (7.0)
11 2 (2.0)
12 3 (3.0)
13 6 (6.0)
14 11 (11.0)
15 26 (26.0)
16 15 (15.0)
17 8 (8.0)
Age not given 15(15.0)
Total 100(100.0)
Mean±SD 12.00± 3.32
1211
AO Abiola et al
Table 3. Factors Associated with Current Cigarette Smoking among Teenagers, Mushin LGA, Lagos state,
Nigeria, 2014
Cigarette smoking
Variables Frequency (%) Statistics & Pvalue
Yes (n=59) No (n=343)
Age
10-14 52 (19.3) 218 (80.7)
15-19 7 (16.2) 125 (83.8)
t=4.283;df=400; p=0.0001
Total 59(14.7) 343(85.3)
Mean±SD 17.20±1.42 16.23±1.65
Gender
Male 56 (22.0) 199 (78.0)
Female 3 (2.0) 144 (98.0) X2=29.5471; df=1; p= 0.0001
Total 59(14.7) 343(85.3)
Marital status
Unmarried 54 (13.7) 340 (86.3)
*p=0.0023
Married 5 (62.5) 3 (37.5)
Religion
Christian 25 (11.7) 188 (88.3)
*p=0.0519
Islam 34 (18.0) 155 (82.0)
Ethnic group
Yoruba 45 (14.9) 258 (85.1)
*p=0.5040
Others (Hausa/Fulani/Igbo) 14 (14.1) 85 (85.9)
Educational Background
≤ Primary School 16 (37.2) 27 (62.8)
*p=0.0001
≥ Secondary school 43 (12.0) 316 (88.0)
Friends influence
Yes 49 (55.7) 39 (44.3)
*p=0.0001
No 10 (3.2) 304 (96.8)
Advert influence
Yes 21 (65.6) 11 (34.4)
*p=0.0001
No 38 (10.3) 322 (89.7)
Parents influence
Yes 7 (11.9) 52 (88.1)
*p=0.0016
No 7 (2.0) 336 (98.0)
Relatives influence
Yes 17 (58.6) 12 (41.4)
*p=0.0001
No 42 (11.3) 331 (88.7)
*Fisher’s Exact tests

Table 4. Determinants of Initiation of Cigarette Smoking among Teenagers, Mushin LGA, Lagos state, Nigeria,
2014
Variables OR CI P
Age (>15 yrs / ≤15 yrs) 5.13 0.87-30.26 0.0709
Gender (Male / Female) 5.19 1.57-17.18 0.007
Marital status (Married/Unmarried) 8.41 1.04-63.35 0.0464
Educational Background
4.31 1.07-17.33 0.0399
(≤ Primary Sch / ≥ Secondary Sch)
Friend (Yes/ No) 308.84 84.87-1123.81 0.0001
Adverts (Yes/ No) 27.83 3.92-197.64 0.0009

relationships between respondents’ age (p=0.0001), smoking (Table 3).

gender (p=0.0001), marital status (p=0.0023), religion
(p=0.0519), educational background (p=0.0001),
friends (p=0.0001), advertisements (p=0.0001), parents
(p=0.0016), relatives (p=0.0001) and current cigarette
1212 Asian Pacific Journal of Cancer Prevention, Vol 17, 2016
A multivariate analysis revealed that teenagers who
were above 15 years, males, married, had ≤ primary
school education, influenced by friends, and influenced
by advertisement are 5.13, 5.19, 8.41, 4.31, 308.84, and

Age of Initiation, Determinants and Prevalence of Cigarette Smoking among Teenagers in Lagos State, Nigeria
Table 5. Determinants of Current Cigarette Smokers
among Teenagers, Mushin LGA, Lagos State, Nigeria
Variables OR CI P as a result of the socio-ethnic differences. Furthermore,
Gender (Male /
12.77 2.90-56.28 0.0008
Female)
Marital status
(Married/ 19.24 2.05-180.45 0.0096
Unmarried)
Educational
Background
7.85 2.37-26.01 0.0007
(≤ Primary Sch / ≥
Secondary Sch)
Friend (Yes/ No) 28.56 10.86-75.07 0.0001
Adverts (Yes/ No) 5.95 1.72-20.61 0.0049
27.83 times respectively more likely to have initiated
cigarette smoking (Table 4). Furthermore, teenagers who
were males, married, had ≤ primary school education,
influenced by friends, and influenced by advertisement
were 12.77, 19.24, 7.85,
Discussion
This study shed some light on the age of initiation,
determinants and prevalence of cigarette smoking among
teenagers in Mushin LGA of Lagos State, Nigeria. The
mean age of initiation of cigarette smoking was 12 ± 3.32
years. Teenagers do not just wake up one day and start
smoking; the uptake of cigarette is as a result of various
factors. The general reasons given for smoking are also
similar to those obtained in this study. The predictors
include: peer influence, siblings smoking, exposure to
advertisements and parental smoking (Das et al., 2011;
Voorhes et al., 2011).
From this study, it was shown that peer influence
(21.9%) was the strongest predictor of smoking followed
by exposure to advertisements (8.0%), and then the
smoking status of relatives (7.2%) and parents (3.5%). In
a Saudi Arabian study, parental influence (6.2%) was the
major predictor of smoking. Studies show that adolescents
with one or both parents who are smokers are associated
with initiation of smoking (Ali et al., 2010). However, the
reason why friends influence was the major predictor of
smoking in this study could be as a result of negligence
on the part of the parents and the environment of the
study subjects.
Findings from this study showed that 32 (8%) of
the respondents that smoke is as a result of exposure to
advertisements, this is because glorification of smoking in
films has a potential to influence smoking initiation among
the youth (Gale et al., 2006). Tobacco packaging itself is
among the most prominent and important forms of tobacco
advertising and promotion. The tobacco industry exploits
all packaging elements, including pack construction, in
addition to graphic design and use of colour, to increase
the appeal of smoking (Hammond, 2011).
According to this study, it was shown that out of the
402 respondents only 100 (24.9%) of the respondents had
ever smoked cigarette while 59 (14.7%) currently smoke
cigarette. This is higher than the finding of a study carried
Asian Pacific Journal of Cancer Prevention, Vol 17, 2016
DOI:http://dx.doi.org/10.7314/APJCP.2016.17.3.1209
out in Northeast Nigeria, in which 18 (15.9%) had ever
smoked and 0.3% are regular smokers who still smoke
(Salawu et al., 2009). The disparity in the results could be
in this study males accounted for 95% of current users
compared to 5% amongst females; this findings agrees
with other studies in Nigeria where males were more likely
to smoke compared with females (Odukoya et al., 2013)
The prevalence of current smokers in this study is
14.7% which is similar to a study carried out in Kajola
Local Government Area, Oyo state, Nigeria where the
prevalence of current smokers was 11.6% (Akindele et
al., 2010) but was lower than the corresponding figures
reported by Lovato among school children where the mean
prevalence of smoking in all age groups was 22.0±3.37%
and the mean prevalence of smoking among 15-19 years
old was 20.3±8.30% (Lovato et al., 2010).
Consistent with findings obtained in similar studies in
many parts of Africa, the lifetime prevalence of smoking
cigarette in this study (24.8%) is lower than among
adolescents in some countries in Asia, notably Japan
(Odukoya et al., 2013).
In conclusion, mean age of initiation of cigarette
smoking was 12.00±3.32 years. Determinants of
cigarette smoking were age, gender, marital status,
educational background, friends and advertisements.
Life time prevalence of cigarette smoking was higher
than prevalence of current cigarette smokers. Cigarette
smoking reduction programs should take these factors
into consideration.
References
Akindele OA, Babalola F, Adesola OS, Owoaje ET (2010).
Tobacco use amongst out of school adolescents in a Local
Government Area in Nigeria. Substance Abuse Treatment,
Prevent Policy, 5, 24.
Aldrich MC, Hidalgo B, Widome R, et al (2015). The role of
epidemiology in evidence- based policy making: a case study
of tobacco use in youth. Ann Epidemiol, 25, 360-5.
Ali IA, Hani T, Ali A (2010). Knowledge, attitude and practice
of tobacco smoking by medical students in Riyadh, Saudi
Arabia. Ann Thorac Med, 5, 145-148.
Australian Institute of health and Welfare (2008). National drug
strategy household survey: detail findings. Drug statistics
series no. 22, cat no. PHE 107. Canberra
Centre for Disease Control and Prevention (2008), Available at
http://apps.nccd.cdc.gov/gtssdata/ancillary/documentation.
aspx?SUID=1&DOCT=1. (Accessed on 27 August 2014).
Das S, Ghosh M, Sarkar M, J et al (2011). Adolescents speak:
Why do we smoke? J Trop Pediatr, 57, 476-80.
David T. Smoking in Asia: A looming health epidemic. Asian
Scientist (2012). Available at http://www.asianscientist.
com/2012/08/features/smoking-in-asia-looming-health-
epidemic.2012. (Accessed on August 15th 2014).
Gale J, Fry B, Smith T (2006). Smoking in film in New Zealand:
measuring risk exposure. BMC Public Health, 6, 243–6.
Global Youth Tobacco Survey Collaborative Group (2002).
Tobacco use among youth: a cross-country comparison.
Tobacco Control, 11: 252-270.
Hammond D (2011). Impact of female-oriented cigarette
packaging in the United States. Nicotine Tobacco Res, 13,
579-88.
Karimy M, Niknami S, Heidarnia AR, et al (2013). Prevalence
1213
AO Abiola et al
and determinants of male adolescents’ smoking in Iran: an
explanation based on the Theory of Planned Behavior. Iran
Red Cres Med J, 15, 187-93.
Leung AK, Hon KL, Kong AY (2009). Fighting tobacco smoking:
a difficult but not impossible battle. Int J Environmental Res
Public Health, 6, 69-83.
Lovato CY, Zeisser C, Campbell HS, et al (2010). Adolescent
smoking: effect of school and community characteristics.
Am J Prev Med, 39, 507-14.
Masibo RM, Mndeme E, Nsimba SED, et al (2013) An
assessment of knowledge, attitudes and practices of
psychoactive substance use among secondary school
students in Dodoma Municipality, Tanzania. American J
Res Commun, 2013, 1, 200-40.
Nazarzdeh M, Bidel Z, Ayuni E, et al (2013). Smoking staus
in Iranian male adolescents: a cross sectional study and a
meta-analysis. Addict Behav, 38, 2214-8.
Odukoya OO, Odeyemi KO, Oyeyemi AS, et al (2013).
Determinants of smoking initiation and susceptibility to
future smoking among school-going adolescents in Lagos
state, Nigeria. Asian Pac J Cancer Prev, 14, 1747-53.
Pampel F (2008). Tobacco use in sub-Sahara Africa: Estimates
from the demographic health surveys. Soc Sci Med, 66,
1772-83.
Poynter M, Bullen C, Whittaker R, Griff M. (2008). ‘Under-18
year old callers to New Zealand’s quitline’, New Zealand
Med J, 121, 24-32.
Salawu FK, Danburam A, Desalu KO, et al (2009). Cigarette
smoking habits among adolescents in northeast nigeria.
mera: African J Respiratory Med, 9, 8-1188.
Schaefer DR, Haas SA, Bishop NJ, (2012). A dynamic model
of US adolescents’ smoking and friendship networks. Am J
Public Health, 102, 12-8.
Voorhees CC, Ye C, Carter-Pokras O, et al (2011) Peers, tobacco
advertising, and secondhand smoke exposure influences
smoking initiation in diverse adolescents. Am J Health
Promot, 25, 1-11.
World Health Organization (2014). Street children, substance
use and health: Monitoring and evaluation of street children
project.
Yan Y, Jacques-Tiura AJ, Chen XG (2014). Application of
the Protection Motivation Theory in predicting cigarette
smoking among adolescents in China. Addic Behav, 39,
181-8.

1214 Asian Pacific Journal of Cancer Prevention, Vol 17, 2016